Can beta-blockers be used for people with COPD?

Chronic obstructive pulmonary disease (COPD) is a disabling condition characterised by largely irreversible airflow obstruction, and affects over 3 million people in the UK. Due in large part to shared risk factors--notably smoking--patients with COPD often also have cardiovascular diseases, such as ischaemic heart disease and heart failure. In these conditions, beta-blockers are valuable management options with proven benefits on symptoms and mortality. Historically, however, clinicians have been reluctant to prescribe beta-blockers for patients with co-existing COPD, due to fear of provoking bronchoconstriction. Moreover, such patients have typically been excluded from trials of beta-blockers, raising additional concerns about the basis for treating them with these drugs. However, withholding beta-blocker therapy might lead to suboptimal treatment for cardiovascular disease among these patients. Here we review the efficacy and safety of beta-blockers in patients with COPD.